Mason Policy Team Advises on Virginia Health Reform

Virginia’s approach to health reform could provide a path for the rest of the country, say Mason professors who provided key input to a state advisory council’s recent report to the governor and legislature.

“Virginia is very important to the nation’s appraisal of this law,” says Len Nichols, director of Mason’s Center for Health Policy Research and Ethics in the College of Health and Human Services (CHHS). “Virginia is a bellwether state in a lot of ways. People pay attention to what we do.”

Nichols and P.J. Maddox, chair of the Department of Health Administration and Policy in CHHS, lent their know-how to the Virginia Health Reform Initiative Advisory Council. The council’s multiple task forces crafted a plan for a health benefit exchange as the Obama administration’s deadline for one approaches. A health benefit exchange could give individuals and small businesses the bargaining power of a large employer so they can land a better health insurance deal.

If Virginia doesn’t have its own health insurance plan in place by January 2013, then it becomes a federal program. “I can assure you that the last thing Virginia wants is to have a federal exchange,” says Nichols, a nationally renowned health policy scholar.

P.J. Maddox. Creative Services photo

Nichols, Maddox and other Mason research-generating team members helped to ensure the advisory board had the facts to make their recommendations. Nichols also paved the way for the Robert Wood Johnson Foundation to fund the council with a $124,484 grant.

Nonpartisan Approach ‘Essential’ for Success

Mason is actively supporting the health care debate. “We’re engaged in Richmond in a way we weren’t before,” Nichols says.

A nonpartisan approach is essential for health reform success, Nichols says. “We’re at a place now where the political leaders have to make basic choices of which direction to go,” he says.

While the U.S. Supreme Court is expected to rule on the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) this summer, Virginia is one of a handful of states to lay the groundwork for health care reform. It’s a gutsy move by a bold governor, says Maddox.

“Virginia has not been on the sidelines, waiting to see what the federal government and other states are doing to implement health reform,” Maddox says. “Even with the uncertainty of the individual mandate, many aspects of the PPACA are going to be implemented. Virginia is wise to move forward to plan how it will implement health reform. There may be controversy about PPACA, but there is wide agreement that we must do more to control the cost of health care, get more value for what we are spending and expand health insurance coverage for many who do not have it.”

A health benefit exchange could save money in the long run because if people have health insurance, they are more likely to go to a doctor early and often, Maddox says. That prevents unnecessary and pricey emergency room visits, she adds.

“If health insurance costs continue to rise and become more unaffordable, fewer will have insurance, and there will be more uncompensated care,” she says. “Those who pay end up paying for those who don’t.”

Putting a Health Benefit Exchange into Action

The advisory council tackled the technical details of how to put a health benefit exchange into action.

“This is about reorganizing the health insurance market in Virginia for people who don’t have offers from their employer and for small employers,” Nichols says. “Those are the two markets that don’t work very well.”

An exchange is designed to boost small employers and regular people into the big leagues. “In essence, an exchange extends the best of our markets to the worst of our markets,” Nichols says.

To do that, some rules have to change.

“You have to sell to everybody, regardless of their health status, and you cannot charge people more just because they’ve had cancer in their lifetime or a heart condition,” Nichols says. “A fundamental shift in the law and the power of government is necessary to make that happen if your goal is to cover all through private insurance.”

Who’s in charge is another issue the council had to address.

A quasi-governmental agency received the nod from the council as the best way to go for an exchange, Nichols says. A health benefit exchange authority would be a governmental entity but with an independent board. Of the 11 states that have created exchanges so far, nine have opted for this approach.

Even if Obama loses the next presidential election, heath care reform may be here to stay, Nichols and Maddox say. “I think it’s highly unlikely this conversation would end with Obama’s defeat,” Nichols says.

Other CHHS team members who helped compile research for the council included health policy fellow Elizabeth Isaacs Flashner, graduate research assistants Suchita Madan and Ekom Etuk and office managers Sandie MacGowan and Caryn Sever.